Geisinger Health System is investing in advanced robotic-arm assisted joint replacement technology to provide a growing number of total knee, partial knee and total hip replacements to its aging patient population.

Using a virtual CT-based 3D model, the Mako robotic-arm assisted surgery system from Stryker enables Geisinger’s surgeons to create each patient’s surgical plan pre-operatively before entering the operating room. And during surgery, they can validate that plan and make any necessary adjustments while guiding the robotic arm, which enables surgeons to more accurately position a joint replacement.

“It all begins with a CT scan of your joint that is used to generate a 3D virtual model of your unique anatomy,” states Geisinger’s patient guide. “This virtual model is loaded into the Mako system software and is used to create your personalized preoperative plan.”

The Mako system “takes information based on an advanced image or CT scan of the affected extremity and it allows us to create a navigation map of the affected joint that we are replacing, so that the robotic arm can help us execute precise cuts that enable us to implant the joint with an unprecedented amount of accuracy,” says orthopaedic surgeon Michael Suk, MD, chief physician officer and chair of the Geisinger Musculoskeletal Institute.

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According to Suk, robotic-arm assisted partial knee replacement has been demonstrated in studies to be two to three times more accurate than manual partial knee replacement procedures.

“One degree of angulation or one millimeter of difference is very difficult to pick up with your naked eye, whereas that level of accuracy is available when you’re using the precision of a robot,” he adds. “The robotic arm is really an extension of the surgeon’s arm and does the physical cutting with us. And the navigation portion allows us to triangulate the correct location in space and time to be able to make that cut exactly where we want it on the anatomy.”

Suk contends that the Mako system enables Geisinger surgeons to leave a “smaller surgical footprint in the sense that we don’t do as much soft tissue dissection because the robotic navigation allows us to be careful of things we can’t see that normally we would have to expose to see.”

As a result, he says that robotic-arm assisted joint replacement leads to faster post-operative recovery for patients. To validate this view, Geisinger is in the process of conducting an analysis of patient recovery times.

Currently, Geisinger has three Mako systems in its inventory, including one at AtlantiCare in New Jersey, and one each at Geisinger South Wilkes-Barre and Geisinger Shamokin Area Community Hospital in Pennsylvania.

“These are the units that we have in place today, but as we develop more experience and gather the validated results, we expect to see, it’s not a far stretch to say that we would be willing to make further investments in order to ensure that the patients in our community get the best technology for the best results,” concludes Suk. “We are just now seeing the front end of the Baby Boomer generation that is hitting Medicare maturity, and that’s the exact population based on the laws of nature that will ultimately require joint replacement.”

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